Incident and Injury Report

Incident and Injury Report

Activity Leader
This report is to be completed by the Activity Leader (Coach, Team Manager/Chaperone, Competition Coordinators, Meet Managers, etc.)

Injury report
- Physical in nature
- First Aid administered
- May involve an incident
- Any incident / injury involving a significant impact to the head, neck, face or body
Incident report
- Violation of the Code of Conduct
- May also involve an injury
Your Name *

First Name Last Name
Email *
example@example.com
Phone Number *

Area Code Phone Number
I am reporting an *

Injury Incident Both
Date of incident/injury
Where did the incident occur? *
include facility/competition name if applicable
Occured during *

Training Competition
Were the Police called?

YES NO
ACTION: Please contact Swim Ontario immediately at darin@swimontario.com

Description of events

surrounding injury - incident
Details *
Other persons who may have witnessed the injury/incident?
Supporting Documents

Browse Files
if applicable Cancel of
Signature

Clear
Should be Empty: